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Reasons for Disclosure in the Physician-Patient Relationship

How Physician Conduct and Reimbursement Methodologies Lead to Fraud and Abuse in Medicare

by Kathleen Johnson

e-Book PDF
Institution: Widener University
Advisor(s): Andrew Fichter, Ph.D., J.D.
Degree: Doctor of Laws
Year: 2010
Volume: 123 pages
ISBN-10: 1599423278
ISBN-13: 9781599423272


The solvency of the Medicare Trust Fund has been debated for the past twenty-five years and despite various stop-gap measures, fraud and abuse continues. Public policy in the form of Stark legislation, anti-kickback laws, and false claims acts were enacted to reduce over-utilization of services and prohibit self-referral and inducements for patients and services.

Despite public policy and continued prosecution of fraud, Medicare reimbursement methods fail to control physician conduct of over-utilization and inducements for referrals.

Following the concept of the informed consent doctrine and the theory of fiduciary trust in the patient-physician relationship, it is the author's thesis that transparency and disclosure with respect to physician prescription and referral practices can mitigate the over-utilization problem.